PB2027: PROGNOSTICATION IN THE EVERYDAY MYELOMA CLINIC. A SYSTEMATIC REVIEW OF PROGNOSTIC MODELS VALIDATED IN REAL WORLD POPULATIONS
Authors: L. Redder, T. Rosenberg, N. Hyldig, S. Möller, N. Abildgaard
Journal: HemaSphere (2022)

Background: Multiple Myeloma (MM) is a severe malignancy with changing treatment possibilities and generally improved survival. However, prognosis is variable, and solid prognostic models for use in the daily clinic are warranted. Several new prognostic models and frailty scores have been introduced, but it can be difficult to keep track of their performance and validation. Aims: To help clinicians prognosticate patients with newly diagnosed MM in the daily clinic, we performed a systematic review of studies validating prognostic models in general MM populations. Methods: A review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA-P) and pre-registered in the International Prospective Register of Systematic Review (PROSPERO) – identification number: CRD42021230604 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=230604. Search strategy Louise Redder, Tine Rosenberg, and Niels Abildgaard created the search strategy in collaboration with a Health Sciences Librarian from the University of Southern Denmark. A broad search string was set up with four search blocks: the first included a validated search filter for finding prognostic and diagnostic predictions studies. The second block searched all MeSH terms for MM. The third block contained an explorative search for progression free survival (PFS) and overall survival (OS), as these were our comparative outcomes and an inclusion criterion. In the fourth block, we attempted to target MM populations as close to the real world as possible, through an explorative search for population, cohort studies, multicenter or single center, and registry. Two systematic literature searches were conducted on the 18th of September 2020 and the 15th of December 2021, using the electronic bibliographic databases, MEDLINE, EMBASE, and the Cochrane Library. Inclusion & exclusion criteria Studies validating or replicating prognostic models predicting OS and/or PFS in a population-based cohort of patients with newly diagnosed MM were included. Cohorts composed by fulfilling inclusion and exclusion criteria in clinical trials were excluded. Further, we excluded cohorts based on specific ethnicities, socioeconomic status, somatic diseases or disabilities, and populations representing other plasma cell dyscrasia, such as plasma cell leukaemia or smouldering MM. A prognostic model was defined as a combination of at least two separate variables predicting patient outcome. The model had to predict OS/PFS at the time of diagnosis. The design could be cohort, nested case-control or case-cohort studies as they are recommended for prognostic model development and validation. Prospective as well as retrospective studies were included, but had to include at least 50 participants and to reflect current treatment. Data had to be collected in 2005 or later. Results: In total 7,128 studies were identified, whereof 1,475 duplicates were removed in Covidence. By screening titles and abstracts, 5,109 studies were found to be irrelevant. Full texts were obtained for 544 studies, and 438 were excluded due to the reasons explained in figure 1. Thus, 106 studies were included in this systematic review. Several studies validate ISS and R-ISS, but also models like the IMWG frailty score, R-MCI, MRP, CCI, IPSI, HCT-CI, KFI, CONUT score, and mSMART were represented in the literature search. See firgure 1. Image:Summary/Conclusion: The work is ongoing. By the end of May 2022, we will be able to present detailed results of our systematic review of prognostic models predicting PFS or OS at the time of diagnosis.